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Diseases & Conditions : Infectious Diseases

Toxic Shock Syndrome

What is toxic shock syndrome?

Toxic shock syndrome, or TSS, describes a cluster of symptoms that involve many systems of the body. The following bacteria commonly cause TSS:

Staphylococcus aureus

Streptococcus pyogenes

TSS from Staphylococcus infections was identified in the late 1970s and early 1980s when highly absorbent tampons, implicated in this infection, were widely used by menstruating women. Due to manufacturing changes in tampons, the incidence of tampon-induced TSS has declined.

TSS from Streptococcus infections is most commonly seen in children and the elderly. Other populations at risk include individuals with diabetes, HIV (the human immunodeficiency virus), chronic lung disease, or heart disease.

How is toxic shock syndrome transmitted?

Staphylococcus infections. Staphylococcus aureus (or S. aureus) may normally exist in a person's nose or vagina and not cause infection. Because it is part of the body's normal bacteria, 90 percent of individuals develop antibodies to prevent infection. S. aureus can be transmitted by direct contact with infected persons. Individuals who develop TSS usually have not developed antibodies against S. aureus. Therefore, it is not usually considered a contagious infection. S. aureus toxic shock syndrome may also occur from S. aureus infections such as pneumonia, sinusitis, osteomyelitis (infection in the bone), or skin wounds such as a burn or surgical site. If any of these areas are infected, the bacteria can penetrate into the bloodstream and cause TSS.

Streptococcus infections. Streptococcus pyogenes (or S. pyogenes) TSS may occur as a secondary infection. Most commonly, this is seen in individuals who have recently had chickenpox or bacterial cellulitis (infection of the skin and underlying tissue).

What are the symptoms of toxic shock syndrome?

The following are the most common symptoms of TSS, however each person may experience symptoms differently.

CDC criteria for Staphylococcus TSS include:

Fever of 102 degrees F or higher

Chills

Malaise (uneasiness and despair)

Headache

Fatigue

Red, flat rash that covers most of the areas of the body

Shedding of the skin in large sheets, especially over the palms and soles (this is seen one to two weeks after the onset of symptoms)

Low blood pressure

Vomiting

Diarrhea

Muscle pain

Increased blood flow to the mouth, eyes, and vagina, making them appear red

Decreased urine output and sediment in urine

Decreased liver function

Bruising due to low blood platelet count

Disorientation and confusion

CDC criteria for Streptococcus TSS include:

Dangerously low blood pressure

Shock

Decreased kidney function

Bleeding problems

Bruising due to low blood platelet count

Red, flat rash that covers large areas of the body

Liver problems

Shedding of the skin in large sheets, especially over the palms and soles (this does not always occur)

Difficulty breathing

The symptoms of TSS may resemble other medical conditions. Always consult your doctor for a diagnosis.

Who is at risk for streptococcal and staphylococcalTSS?

Streptococcal and staphylococcal TSS risks may include the following:

A history of using super-absorbent tampons

Surgical wounds

A local infection in the skin or deep tissue

History of using the diaphragm or contraceptive sponge

History of childbirth or abortion

How is toxic shock syndrome diagnosed?

Ruling out similar illnesses, such as Rocky Mountain Spotted Fever, among others, is critical in diagnosing TSS. In addition, confirmation is made in children and adults who meet the CDC criteria for TSS. Other diagnostic studies may include:

Blood cultures. These tests are used to find and identify microorganisms.